Life in a day: connecting Roma communities to health services (and more)

At the health centre in Cukarica on the outskirts of Belgrade, a Roma couple in their late teens are waiting nervously for Zorica Stanojevic. Rujezi and Merlina are expecting their first child, and are here for aroutine check-up. They could go straight to the maternity unit, but they prefer to wait until Zorica is free to go with them, make the introductions and generally smooth the way.For Zorica, this is a regular part of her job as a Roma Health Mediator. "They don't always have to come through me," she says. "They have the right to health and they can just come here themselves."

But for now, Rujezi and Merlina are more comfortable talking to Zorica, who speaks their language, comes from the same background and who understands their anxieties.

Once the couple are settled in the maternity unit, Zorica sets off for the first of her five visits today to check on a new mother and her baby in the Roma settlement of Padina.

Making the connections

These personal visits are vital. A deadly combination of intense poverty, bad living conditions and poor nutrition meant that Roma children born in 2010 were twice as likely as non-Roma children to be born underweight, and twice as likely to die before their fifth birthday.

Serbia's Roma people are among the most marginalized in the country, with around half living below the poverty line and many still living in illegal settlements.A history of deep mutual mistrust between Roma communities and health services only adds to the problems, with Roma parents often unaware of their legal rights to health care. One example of the impact can be seen in low immunization rates for Roma children, with only just over one quarter – 27 per cent – fully immunized against preventable diseases.

Tackling such problems requires more than extra health leaflets written in the Roma language, or 'more of the same' health services that have failed to reach Roma communities in the past. What is needed is a channelto create a permanent connection between Roma communities and Serbia's health systems.That is why the Ministry appointed the first 15 Roma Health Mediators (RHMs) in 2008.

What nobody predicted was that this initiative, with its emphasis on Roma leadership and solutions, would help Roma to claim their rights not only to health, but to a whole range of other services.It is now playing a key role in Serbia's push for social inclusion, helping service providers to meet their obligations under the law.

Today, Zorica is one of 75 RHMs working with Roma communities and health services across Serbia – all of them Roma mothers, and all with at least a primary education.

In Padina

As Zorica walks through the Padina settlement, she points out the cabins made of packing cases and scrap metal, and the unpaved clay that turns into a quagmire each time it rains. She talks about the lack of electricity and running water. But the fact that Padina is an illegal settlement is, she feels, as big a challenge as the mud and the lack of utilities. The people who live here do not, officially, 'exist', and have no proof of residence. She calls on Fikneta Selmoni, who is bathing her first child, four-month old Sylvia. With encouragement from Zorica, Fikneta gave birth in hospital. "She helped me get an appointment to see a gynaecologist when I was pregnant," says Fikneta. "She made sure that I got all the help I needed."

Sylvia is wrapped in a towel and handed to her grandfather Naim Selmoni. He is ecstatic about Sylvia,who is his first grandchild: "She's like a queen", he says. "This is the biggest, the happiest thing in my life."

When Zorica first visited Padina, it took time to build trust. Naim, like many others, was understandably wary of false dawns and broken promises. He talks with some frustration about the official visitors who parade through his settlement, many of whom make extravagant promises before disappearing. Not surprisingly, new arrivals are greeted with some scepticism, and Zorica was no exception.

"But she has helped us enormously," says Naim."Nobody here had health insurance. Now, with her help, we all have it. Nobody here ever went to a doctor. Now Zorica makes appointments when we need them. And our children are vaccinated.So many people come to visit, but a lot of them cheat us, making promises and never coming back. But Zorica does what she says she will do."

Zoricasays that RHMs have one simple rule: "We never make promises we can't keep".

She recalls a 2 am phone call about a woman in early labour. Zorica phoned for an ambulance, only to be told that it would not comeas it might sink in the mud. Zorica, a soft-spoken woman, admits that she snapped at the dispatcher, "I'm talking about two lives here, and you're talking about mud?"

Moving swiftly to 'plan B',Zorica woke her own father and insisted that he drive her to Padina. By the time they arrived, the baby was already born, and her weary father turned his car around and drove mother and baby to the hospital where they received emergency care. Both are now thriving.

Beyond healthThe health of Roma communities does not depend solely on access to health centres. Because they face complex challenges that affect their health, the role of Roma Health Mediators has had to evolveto include advice on everything from birth certification to school enrolment, and from safe sex to human rights.

Naim tells Zorica, for example, that one of his youngest children is about to go to school and needs a birth certificate. Zorica talks him through the process, promising to follow up with him on her next visit.

RHMs keep track of the children who are attending – or should be – attending school, reinforcing the message that schooling is free, including textbooks.Zorica, who completed secondary education, is acutely aware of her responsibility as a role mode, taking great pains to ensure that she is always immaculate, always professional and always available. "I am always trying to convey the idea that knowledge, that education, is essential for the future," she says.

Building Serbia's first database on Roma communities

One of the biggest challenges to Roma communities is that they are 'invisible'. Nobody even knows for sure how many Roma there are in Serbia, with estimates ranging from 180,000 to 450,000.

Zorica and the other RHMs play a unique role by gathering information on Roma communities every single day, as part of their work. They are gathering statistics not only on Roma living standards, health and education, but on where and how the Roma live, statistics that were previously gathered in one-off surveys years apart, among a population that is often on the move.

Their work has been transformed by a ground-breaking tri-partite agreement between UNICEF, the Ministry of Health and a private sector mobile phone company, Telenor, that has created Serbia's first ever database on its Roma population.

In 2008, the first RHMs had to log everyhealth visit into blue books the size of suitcases. They had to use their own mobile phones to call families, health centres and each other.

In 2010, Telenor came in with the mobile technology to improve the whole process. The company wanted to do more than write a cheque – it wanted to use its expertise to boost the impact of the work of the RHMs.

Telenor provided every RHM with a mobile phone and with a laptop, complete with software developed with the Ministry of Health and UNICEF to capture information on Roma families. In addition to equipment, Telenor has provided Internet connection and a special tariff package for the RHMs – and this is what really helps them to connect to health services and Roma communities. They have been trained to use the laptops, to enter the precious data, and to send the information through to health centres.

RHMs can now cross-check with colleagues in other parts of Serbia. A colleague from Niš, for example, tracked a family that had moved to Belgrade via Zorica's laptop, and was able to pass on their health information.The RHMs take this part of their work very seriously. There is the story of one RHM in a remote part of southern Serbia who scrambled up a tree to get the signal she needed to send data to the health centre. "It's now much easier because of the database," says Zorica. "We have all the details of all the families with a push of the button".

The results

The Roma Health Mediators have had a dramatic impact in just four years. The health centre in Cukarica, for example, has seen a surge in the numbers of Roma women demanding ante-natal care and hospital births. And the percentage of Roma children being vaccinated in Cukarica is fast approaching 100 per cent, on a par with the national average.

Across Serbia, RHMs have collected key data on more than 120,000 Roma people – 96,000 of them since the arrival of the new laptops. As a direct result of their work, registration cards have been completed for families in more than 800 Roma settlements, more than 8,000 children have been vaccinated, almost 5,000 Roma women have visited a gynaecologist and more than 1,300 Roma children have been admitted to school.

"It's a humane job" says Zorica. "It's about humanity.I used to have sleepless nights worrying about these families. Now that is changing. They are satisfied and we are satisfied."